Both healthcare spending levels and growth in the US have exceeded other developed countries for many years. With healthcare costs rising at an unsustainable pace, a greater percentage of workers in the US are being enrolled in high-deductible health plans. This column estimates the relationship between high deductibles and the growth in total healthcare spending on all medical goods and services. It finds that deductible levels have a considerable effect on spending growth, and suggests that the natural next step is to explore whether or how that affects health outcomes.

Population ageing is one of the most commonly cited drivers of rising healthcare spending. However, other non-demographic cost pressures, such as increasing relative health spending and technological advancement, also contribute substantially over the longer term. This column argues that taking these additional factors into account, the UK’s net public debt due to healthcare is projected to be up to twice as large in 2066. These findings stress the importance of balancing the budget as early as possible to keep public finances on a sustainable path.